Hsia, Y-F; (2015) Efficacy, Safety and Epidemiology of Anti-Obesity Drug Prescribing in Children and Adolescents. Doctoral thesis , UCL (University College London).

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Abstract

Three drugs were approved for obesity treatment in the UK between 1998 and 2006: orlistat, sibutramine, and rimonabant; however the latter two drugs were withdrawn from the market. The National Institute for Health and Clinical Excellence guidelines (NICE) issued in recommended that anti-obesity drugs were appropriate for obesity management in children and adolescents aged ≥ 12 years in certain circumstances. Currently, there is little evidence on drug use for obesity treatment in young people in the UK. From a meta-analysis of RCTs, after 6 months of treatment, orlistat together with behavioural therapy reduced body mass index (BMI) by 0.83 mg/m2, with a high number of gastrointestinal adverse drug reactions (ADRs). Sibutramine with behavioural therapy reduced BMI by 2.20 mg/m2. Between 1999 and 2006, the use of anti-obesity drug in primary care increased 15-fold. Approximately 45% of orlistat and 25% of sibutramine prescriptions were discontinued after one month of treatment. This may indicate that these drugs were not effective or poorly tolerated in children. A meta-analysis of 12 RCTs on metformin has shown a BMI reduction by 0.64 mg/m2 in obese young people without diabetes. A cohort study from a paediatric obesity clinic has shown that metformin was the most commonly prescribed drug. Metformin together with lifestyle intervention was shown a small but statistically significant effect on reducing the BMI standard deviation score in girls compared to lifestyle intervention alone after 6 months of treatment. The questionnaire study shows that over half of GPs who initiated drug prescriptions to obese young patients did not consult specialists for advice. Despite NICE guidance, GPs expressed a need to have an obesity guidance covers pharmacological and non-pharmacological interventions. As there is increased use of metformin for obesity treatment, in both primary and secondary care, clinicians should use the most up-to-date evidence when prescribing metformin for treatment in young people.

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